Narcan atomizer

[myrandom2003]

Anyone prescribing to patients, that are getting daily opioids, narcan atomizer and mandatory training of family members?

I am thinking of implementing this for the small handful of patients that I have that I do prescribe medications too. I think the max meq patient I have is 60mg. It may be overkill but I am contemplating on making this mandatory for all my opioid patients. I can try to do some sort of overdose risk reduction and it may give me a false sense of security so I sleep a bit easier.

I think for the patients that live alone I will still prescribe this and train them on how to use it anyway.

I am also thinking about requiring a sleep study as well for those over 40meq. There is no compelling evidence for me to do this other than trying to find a way to evaluate for respiratory depression from the medication and if they are getting apnea, decrease dose.


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[lobelsteve]

Anyone prescribing to patients, that are getting daily opioids, narcan atomizer and mandatory training of family members?

I am thinking of implementing this for the small handful of patients that I have that I do prescribe medications too. I think the max meq patient I have is 60mg. It may be overkill but I am contemplating on making this mandatory for all my opioid patients. I can try to do some sort of overdose risk reduction and it may give me a false sense of security so I sleep a bit easier.

I think for the patients that live alone I will still prescribe this and train them on how to use it anyway.

I am also thinking about requiring a sleep study as well for those over 40meq. There is no compelling evidence for me to do this other than trying to find a way to evaluate for respiratory depression from the medication and if they are getting apnea, decrease dose.


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No reason for any of this with your current patients and dosing.
Over 50meq could consider. Over 90 should Rx some form of Narcan.

 

[myrandom2003]

I know that it's overkill, but with some of my oldies I get a little concerned. I don't know if their afternoon naps are because of the meds or they just want to take a nap.

I was just wondering if any of you did anything like this? I don't like being much of an outlier. I'm fine being right in the middle of the pack.


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[Ducttape]

i do this of those I prescribe who is over 60 MED, and for all patients I see who are prescribed by others who are on over 90 MED, lower if they are concurrently on benzos. Harm reduction. and sometimes scares the family so much that they convince the patient to taper.

in certain states, it is available "over the counter" at pharmacies such as Wegmans (or Walgreens or Rite Aid).

 

[Lecithin5]

Although I think the benefits outweigh risks, anyone concerned about potential consequences of narcan (ie sympathetic overload, etc)? Otherwise, heck, why not prescribe narcan to any patient on any amount of opioids?

 

[bedrock]

Although I think the benefits outweigh risks, anyone concerned about potential consequences of narcan (ie sympathetic overload, etc)? Otherwise, heck, why not prescribe narcan to any patient on any amount of opioids?

It does happen. As a resident I saw a patient have an MI from narcan. I would only give it to truly high risk patients, oh wait, if I'm that worried their opioids will kill them then I lower their dose, done problem solved.

Anyone who gives out narcan is prescribing too high doses to their patients.

 

[lobelsteve]

It does happen. As a resident I saw a patient have an MI from narcan. I would only give it to truly high risk patients, oh wait, if I'm that worried their opioids will kill them then I lower their dose, done problem solved.

Anyone who gives out narcan is prescribing too high doses to their patients.

Legacy.

It is what you do while trying to wean down folks to 90meq or lower.

 

[DODOCSS]

>45MED

plum issues (osa, copd, etc)

don't rx opioids if on benzo


Rx for opioid always says "required to fill narcan"

 

[Ducttape]

It does happen. As a resident I saw a patient have an MI from narcan. I would only give it to truly high risk patients, oh wait, if I'm that worried their opioids will kill them then I lower their dose, done problem solved.

Anyone who gives out narcan is prescribing too high doses to their patients.

if you are not considering whether to provide narcan for even the lowest dose patients (doesn't mean you are going to prescribe, for tramadol for example), you are not considering harm reduction as part of the intake strategy...

 

[bedrock]

>45MED

plum issues (osa, copd, etc)
don't rx opioids if on benzo
Rx for opioid always says "required to fill narcan"

The Rx for opioid that says required to fill narcan I suspect is a state thing. What state are you in?
Agree never rx opioids if pt on benzo
pulm issues can be tricky. I typically restrict patient either low dose regular opioid like norco 5 BID or mandate buprenorphine either orally or butrans, even if it's expensive for the patient.

prescribing moderate or high doses of regular opioids to a pulmonary compromised patient (excluding 6 month terminal patients), is a bad idea IMHO. I flat out tell them they will have to live with more pain than someone without lung disease because I'm not going to prescribe them moderate-high doses of standard opioids, have them die and be blamed for it.
Narcan won't save them if they go apneic at night while their partner is sleeping.

Legacy.
It is what you do while trying to wean down folks to 90meq or lower.

understand and agree with narcan for this situation

 

[bedrock]

i do this of those I prescribe who is over 60 MED, and for all patients I see who are prescribed by others who are on over 90 MED, lower if they are concurrently on benzos. Harm reduction. and sometimes scares the family so much that they convince the patient to taper.
.

I simply wouldn't allow my patient to take benzos if they're on opioids. They get one or the other, done, end of story. I won't accept additional risk to my license because they're a chemical coper.

I do like the idea of introducing narcan to patients at the upper limits of whatever you normally prescribe, while simultaneously explaining this is because there is a real risk of dying from their opioid dose.
Might motivate some to taper, although again if I'm worried about their doses, I simply tell them their dose will be tapered because I feel that dose is not safe long-term in my expert medical opinion. If the patient cant accept that, then they can go find another doctor who is more cavalier with his license.

 

[deleted185747]

I blow atomized narcan thru this, mounted over the front door of the office with a sign outside warning that no one on opioids is permitted to enter.

Curtron AP-2-36-1-PC Air-Pro White Powder Coated Air Curtain - 120V